Murasato Yoshinobu, Kinoshita Yoshihisa, Yamawaki Masahiro, Okamura Takayuki, Nagoshi Ryoji, Fujimura Tatsuhiro, Takeda Yoshihiro, Fujii Kenichi, Yamada Shin-Ichiro, Shinke Toshiro, Shite Junya
Department of Cardiology and Clinical Research Centre, National Hospital Organization Kyushu Medical Centre, 1-8-1, Jigyohama, Chuo, Fukuoka, 810-8563, Japan.
Department of Cardiology, Toyohashi Heart Centre, Toyohashi, Japan.
Cardiovasc Interv Ther. 2025 Jan;40(1):79-88. doi: 10.1007/s12928-024-01057-7. Epub 2024 Oct 29.
Physiological coronary branching at the bifurcation has a constant fractal ratio (FR) of the diameter of the mother vessel to the sum of daughter vessels on quantitative coronary angiography (QCA). We sought to investigate the FR of diseased coronary bifurcations using QCA and intravascular ultrasound (IVUS) and its impact on late lumen loss after percutaneous coronary intervention (PCI). In multicentre prospective studies of the J-REVERSE and 3D OCT Bifurcation Registry, 402 and 109 bifurcations treated with stenting that completed QCAs and IVUS examinations, respectively were analysed. FR was investigated at the reference sites pre-PCI and the minimum lumen diameter (MLD) post-PCI. In the QCA analysis, constant FR was observed in the pre-PCI reference (0.62 ± 0.08) and in the post-PCI MLD site (0.74 ± 0.10), which was greater (p < 0.05). In the IVUS analysis, the constant FR in the post-PCI MLD site (0.67 ± 0.06) was similar to that in the pre-PCI reference (0.66 ± 0.06) and close to the physiological FR value (0.678). The fourth quintile of pre-PCI reference FR in the IVUS analysis showed numerically least late lumen loss in proximal main vessel (MV) (0.16 ± 0.22 mm) and distal MV (0.13 ± 0.32 mm) and significantly less in the side branch compared to higher FR quintile (- 0.14 ± 0.27 mm vs. 0.10 ± 0.19 mm, p = 0.004), while no relationship was found in the QCA analysis. FR in the diseased coronary bifurcation was more accurately assessed on IVUS than on QCA, and the accomplishment of physiological FR might lead to less late lumen loss after bifurcation PCI.
在定量冠状动脉造影（QCA）中，生理性冠状动脉分叉处母血管直径与分支血管直径之和具有恒定的分形比（FR）。我们试图使用QCA和血管内超声（IVUS）研究病变冠状动脉分叉处的FR及其对经皮冠状动脉介入治疗（PCI）后晚期管腔丢失的影响。在J-REVERSE和3D OCT分叉注册研究的多中心前瞻性研究中，分别分析了402例和109例完成QCA和IVUS检查的接受支架置入治疗的分叉病变。在PCI前的参考部位和PCI后的最小管腔直径（MLD）处研究FR。在QCA分析中，PCI前参考部位（0.62±0.08）和PCI后MLD部位（0.74±0.10）观察到恒定的FR，后者更大（p<0.05）。在IVUS分析中，PCI后MLD部位的恒定FR（0.67±0.06）与PCI前参考部位（0.66±0.06）相似，且接近生理性FR值（0.678）。IVUS分析中PCI前参考FR的第四个五分位数在近端主血管（MV）（0.16±0.22mm）和远端MV（0.13±0.32mm）中显示出数值上最小的晚期管腔丢失，与较高FR五分位数相比，侧支血管中的晚期管腔丢失明显更少（-0.14±0.27mm对0.10±0.19mm，p=0.004），而在QCA分析中未发现相关性。与QCA相比，IVUS能更准确地评估病变冠状动脉分叉处的FR，实现生理性FR可能会减少分叉病变PCI后的晚期管腔丢失。
